Back to HealthCare.Gov to Shop for Plans in Open-Enrollment Period for 2015
By: Ann Carrns (NY Times) October 2014
On Nov. 15, the second open-enrollment period will begin for individual health care coverage under the Affordable Care Act. Those who didn’t sign up previously can enroll for coverage starting in 2015, and those who are already covered can renew or change their policies.
Officials at the federal Centers for Medicare and Medicaid Services, which run HealthCare.gov, the federal insurance marketplace, have said that people who are already enrolled will be automatically re-enrolled.
But consumer advocates and policy experts are urging consumers not to put their insurance renewal on autopilot. Rather, they advise that when open enrollment starts, they should log on to HealthCare.gov, or their state-based marketplace authorized by the health care act, to comparison-shop to make sure their current plan is still the best choice. It’s especially important to do so, they say, if you received federal tax credits that lowered your monthly premiums — as most people did.
“They really should go in and actively re-enroll, and do some shopping around,” said Sabrina Corlette, senior research fellow at the Center on Health Insurance Reforms at Georgetown University. “Premiums are changing pretty dramatically.”
PriceWaterhouseCooper’s Healthcare Institute found that on average, premiums for individual insurance plans are expected to increase a relatively modest 6 percent, but there are wide variations and some markets are seeing decreases, in part thanks to competition from new plans.
There’s good reason to not renew your A.C.A. health plan blindly, said Larry Levitt, senior vice president at the Kaiser Family Foundation. For starters, he said, if you auto-renew, you’ll most likely be assigned the same tax credit as you had for 2014. But if your income has increased, your credit may be too large — and you could end up owing the government money, when the numbers are reconciled at tax time. Consumers are supposed to report changes in income during the course of the year, he said, but it’s likely that many have not. So by re-enrolling and updating details about income, you’ll help make sure the credit is properly adjusted.
Also, because of a quirk in the way the A.C.A. calculates the tax credits, some consumers who stick with their same plan actually could end up paying more — even if their original plan doesn’t raise its rates.
How can that be? The tax credit you receive is determined based on your income, and the cost of coverage in your market (specifically, the cost of a silver-tier “benchmark” health plan). If you choose a costlier plan, you get the same size credit, and pay the difference yourself.
But because health plans are adjusting their rates and new offerings are entering the fray, the plans that served as benchmarks for this year may not be the same next year; different plans with lower premiums may provide the new benchmark, reducing the size of the accompanying tax credits. (A preliminary Kaiser analysis in September found that average premiums for benchmark plans in 16 major cities would drop slightly.) That means the size of your credit may shrink, leaving you with a higher monthly payment if you stick with your same plan. “There are big changes in many places in the constellation of what is being offered,” Mr. Levitt said.
(Mr. Levitt cites this example, from Kaiser’s market analysis, to show how this could happen. In Denver in 2014, the “benchmark” silver plan was one offered by Humana, with a monthly premium of $250 for a 40-year-old. For someone making $30,000, the premium contribution was $209, with the difference made up by a tax credit of $41.
For 2015, however, the benchmark silver plan will most likely be one offered by a new cooperative insurer, with a premium of $211. The income-based payment for the same 40-year-old earning $30,000 dropped slightly, to $208, requiring a tax credit of just $3 to bridge the gap.
The 2015 premium for Humana’s plan, however, is $249. After applying the $3 tax credit, the consumer’s payment would be $246 — an increase of about 18 percent over this year’s premium, even though Humana’s pre-credit premium actually dropped by a dollar.)
Of course, you might still want to keep your plan, even if it costs you more — perhaps because you like the doctors in its network. But you should make an informed choice, Mr. Levitt said: “They should be going in with their eyes open.”
Here are some questions about the coming open enrollment:
■ When is open enrollment?
Open enrollment this time around runs from Nov. 15 to Feb. 15. (The dates are the same for states where the federal government has a role in running the exchanges, as well as in states with their own marketplaces; some states may allow earlier renewals, however, so it’s best to check with your state exchange for details).
■ How soon can coverage begin?
If you want coverage starting Jan. 1, you must enroll by Dec. 15. While federal officials say they expect the federal marketplace to operate much more smoothly this time, Ms. Corlette advised signing up earlier rather than later. “Don’t wait until Dec. 14,” she said.
■ What is the penalty for failing to have insurance coverage?
Under Affordable Care Act rules, the penalty for being uninsured in 2015 rises to $325 per adult, or 2 percent of your yearly income, whichever is greater.
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